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Surgical Technique
Customer Service: 888.499.0079www.extremitymedical.com
Patent and Patent PendingCAUTION: Federal Law (USA) restricts this device to sale by or on the order of a physician.
Customer Service: 888.499.0079www.extremitymedical.com
Surgical Technique
Customer Service: 888.499.0079www.extremitymedical.com
INDICATIONS FOR USE
The APEX IP Fusion Device is intended for reduction and internal fixation of arthrodesis of the interphalangeal joints of the hand.
Pre-Operative Planning - TemplatingThe APEX IP Fusion Device System provides several Post sizes and angles. Use the X-ray template to determine the optimal size, angle, and position of the construct for the intended application.
A dorsal longitudinal incision is made over the PIP joint, extending from the mid-proximal phalanx to the mid middle phalanx. The extensor tendon is incised longitudinally in its midline over the entire length of the skin incision. Each half of the tendon is reflected laterally during which its insertion on the middle phalanx is released. Flex the PIP joint to expose the joint surfaces of the proximal and middle phalanges.
STEP 1 - Exposure & Joint Preparation
STEP 2 - Initial Guidewire
Insert a Ø0.9mm guidewire into the canal of the proximal phalanx and confirm its central location in the canal using fluoroscopy.
Surgical Technique
Customer Service: 888.499.0079www.extremitymedical.com
STEP 3 - Post Depth Measurement
Drill utilizing the 2.7mm cannulated drill to the measured depth. The 2.7 drill side of the Short Tapered Guide may be used to protect the adjacent soft tissues.
STEP 4 - Preparation for Post: Pilot Drill
Slide the depth gauge over the Post guidewire until flush with the joint surface to measure the length of the Post. Ensure the reading is made from the side of the guide labeled “X-Post™ Depth.”
Surgical Technique
Customer Service: 888.499.0079www.extremitymedical.com
STEP 5 – Preparation for Post: Reaming
STEP 6 - Post Insertion
Select the proper Post and align the bold laser mark on the implant with the laser line and arrow on the 2.0 mm hex driver. Using the hex driver, insert the Post until its dorsal rim is sunk 1-2mm below the dorsal cortical rim of the phalanx, and align the laser line and arrow with the dorsal aspect of the finger to ensure proper rotation for the arthrodesis.
Place the cannulated Reamer over the guidewire and advance by hand until the depth line (bold laser mark) is buried approximately 1-2 mm beneath the joint surface.
Surgical Technique
Customer Service: 888.499.0079www.extremitymedical.com
STEP 7 - Clear the Volar Aspect of the Middle Phalanx Using the Clearing Tool
STEP 8a - Joint Preparation & Dorsal Window Clearing
Insert the X-Post™ Clearing Tool into the eyelet of the Post at the angle matching the selected Post (30 or 45 degrees) and rotate by hand until the stop on the rasp contacts the implant surface. Protect the dorsal soft tissues as the rasp exits the bone dorsally.
Note: Due to the geometry of the implant, the rasp will not appear visually flush with the adjacent surface on the dorsal side of the implant.
Surgical Technique
Remove the bone from the volar aspect of the middle phalanx to allow for the X-Post™ Clearing Tool to seat properly. This step can be completed with the Clearing Tool as depicted below, or alternatively with a Rongeur.
Customer Service: 888.499.0079www.extremitymedical.com
STEP 8b – Dorsal Window Clearing
STEP 9 – Guidewire Insertion
Insert another Ø0.9mm guidewire into the canal of the middle phalanx and verify its central position in the canal with flouroscopy.
Clear and enlarge the hole made by the Dorsal Window Reamer with the Dorsal Window Reamer by rotating manually at the angle of selected Post.
Surgical Technique
Customer Service: 888.499.0079www.extremitymedical.com
STEP 10 - Lag Screw Depth Measurement
Slide the depth gage over the guidewire until flush with the joint surface to determine the length of the Lag Screw.
STEP 11 - Pilot & Distal Rasping
Advance the Distal Rasp over the guidewire and rasp the joint surface until it is flat and metaphyseal bone is exposed.
Surgical Technique
Insert the Lag Screw using TWO finger pressure until compression is felt and visualization confirms the Lag Screw is flush against the Post. The Morse Taper engagement should be felt as the Lag Screw becomes engaged in the Post.
Customer Service: 888.499.0079www.extremitymedical.com
STEP 12 - Insert Lag Screw
POSTOPERATIVE TREATMENT
Subsequent to tendon and skin closure, the finger is immobilized in a padded splint for two weeks postoperatively. Further care follows the standard postoperative protocols for arthrodesis as preferred by the surgeon. Progression of movement and transition out of cast immobilization is individually based depending on bone quality and expected healing rate.
ARTHRODESIS OF THE THUMB INTERPHALANGEAL JOINT
The same basic technique is used when performing an arthrodesis of the thumb IP joint however the distal phalanx of the thumb is often more curved than the middle phalanx of the finger and thus Lag Screw placement must be adjusted accordingly.
IMPLANT REMOVAL
Remove any tissue ingrowth from the Lag Screw. Insert the driver into Lag Screw and completely remove it. Insert the driver into the Post and remove it by turning counterclockwise.
Surgical Technique
Customer Service: 888.499.0079www.extremitymedical.com
Surgical Technique
NOTES:
Customer Service: 888.499.0079www.extremitymedical.com
Surgical Technique
NOTES:
300 Interpace Parkway • Suite 410 • Parsippany, NJ 07054 Phone: 973.588.8980 • Customer Service: 888.499.0079 • Fax: 888.499.0542
www.extremitymedical.com
0086LBL-121-99102-EN Rev A
06/2013
Surgical Technique
Reference # Description QtyMedium PIP Post - 4.0 x 16mm (30 deg)
Medium PIP Post - 4.0 x 20mm (30 deg)
Medium PIP Post - 4.0 x 16mm (45 deg)
Medium PIP Post - 4.0 x 20mm (45 deg)
Large PIP Post - 4.6 x 16mm (30 deg)
Large PIP Post - 4.6 x 20mm (30 deg)
Large PIP Post - 4.6 x 16mm (45 deg)
Large PIP Post - 4.6 x 20mm (45 deg)
Posts
121-40316
121-40320
121-44516
121-44520
121-50316
121-50320
121-54516
121-54520
2
2
2
2
2
2
2
2
Reference # Description QtyLag Screw (Solid Tapered) 3.0 x 16mm
Lag Screw (Solid Tapered) 3.0 x 18mm
Lag Screw (Solid Tapered) 3.0 x 20mm
Lag Screw (Solid Tapered) 3.0 x 22mm
Lag Screw (Solid Tapered) 3.0 x 24mm
Lag Screw (Solid Tapered) 3.0 x 26mm
Lag Screw (Solid Tapered) 3.0 x 28mm
Lag Screw (Solid Tapered) 3.0 x 30mm
Lag Screw (Cannulated Tapered) 3.0 x 16mm
Lag Screw (Cannulated Tapered) 3.0 x 18mm
Lag Screw (Cannulated Tapered) 3.0 x 20mm
Lag Screw (Cannulated Tapered) 3.0 x 22mm
Lag Screw (Cannulated Tapered) 3.0 x 24mm
Lag Screw (Cannulated Tapered) 3.0 x 26mm
Lag Screw (Cannulated Tapered) 3.0 x 28mm
Lag Screw (Cannulated Tapered) 3.0 x 30mm
Screws
121-30016
121-30018
121-30020
121-30022
121-30024
121-30026
121-30028
121-30030
127-30216
127-30218
127-30220
127-30222
127-30224
127-30226
127-30228
127-30230
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
10
2
1
1
1
1
1
1
1
2
1
1
2
1
1
1
1
1
1
1
Reference # Description Qty
Guidewire - 0.9mm
Cannulated Drill – 2.0mm
Cleaning Brush - 0.9mm
4.6 X-Post Reamer
8mm Proximal Rasp
10mm Proximal Rasp
8mm Distal Rasp
10mm Distal Rasp
APEX X-Ray Template
Cannulated Drill – 2.7mm
Guidewire Holder - 0.9mm
AO Quick Connect Handle
2.0 Hex Driver
APEX Instrument Tray
APEX Implant Caddy
Dorsal Window Reamer
Short Tapered Guide – 4.6mm
X-Post Clearing Tool
Small AO Handle
Depth Gauge – 0.9mm
Instruments
101-00004
101-00011
101-00022
118-00004
121-00108
121-00110
121-00208
121-00208
121-00007
127-00027
101-00008
102-00017
118-00020
121-00000
121-00001
121-00002
127-00003
127-00005
127-00006
127-00010
Disposable Instruments
Re-Usable Instruments